Provider Demographics
NPI:1437981529
Name:RIVERA MALAVE, GABRIELA MARIE
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:MARIE
Last Name:RIVERA MALAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 6097-2
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-9690
Mailing Address - Country:US
Mailing Address - Phone:787-307-0233
Mailing Address - Fax:
Practice Address - Street 1:1226 CALLE CADIZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-3841
Practice Address - Country:US
Practice Address - Phone:787-428-7939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8013103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist